Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000600014
Brazilian Journal of Anesthesiology
Review Article

Hiperalgesia visceral e dor abdominal crônica: abordagem diagnóstica e terapêutica

Visceral hyperalgesia and chronic abdominal pain: diagnostic and therapeutic approach

Durval Campos Kraychete; Ana Cristina Guimarães

http://dx.doi.org/10.1590/S0034-70942003000600014 Braz J Anesthesiol, vol.53, n6, p.833-853, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: A dor abdominal crônica é uma das razões mais freqüentes para consulta médica. Não existe, entretanto, um protocolo bem estabelecido para a abordagem diagnóstica e, na maioria das vezes, essa investigação se torna uma prática médica onerosa e invasiva. A finalidade desta revisão é tentar esclarecer a fisiopatologia da dor visceral e estabelecer metas diagnósticas e terapêuticas, para portadores desta morbidade, baseada em critérios específicos. CONTEÚDO: A dor abdominal crônica inespecífica ou funcional representa uma interação complexa entre distúrbio de motilidade, hipersensibilidade visceral e respostas neuroendócrina e psicossocial inadequadas. Mecanismos periféricos e centrais de nocicepção parecem estar envolvidos na hiperalgesia visceral. A abordagem diagnóstica requer uma avaliação minuciosa da história e exame clínico, levando em consideração os critérios de Roma II. Baseado nos mecanismos fisiopatológicos conhecidos, ou supostos, novas drogas vêm sendo pesquisadas, e algumas utilizadas mais recentemente, como os agonistas dos receptores 5-HT4 e bloqueadores dos canais de sódio, para o controle da dor abdominal. CONCLUSÕES: Os mecanismos fisiopatológicos da dor abdominal crônica, ainda não estão esclarecidos. A abordagem terapêutica e diagnóstica requer o conhecimento de tais mecanismos, bem como dos critérios de Roma II. Por outro lado, uma boa relação médico-paciente e a atuação de equipe intermultidisciplinar parecem fundamentais para melhorar a resposta ao tratamento instituído e a qualidade de vida do paciente.

Palavras-chave

DOR, DOR

Abstract

BACKGROUND AND OBJECTIVES: Chronic abdominal pain is one of the most frequent reasons for medical consultation. There is, however, no well-established protocol for its diagnostic approach and, most of the times, investigation becomes an expensive and invasive medical practice. This review aimed at explaining visceral pain pathophysiology and establishing diagnostic and therapeutic goals for these patients, based on specific criteria. CONTENTS: Chronic nonspecific or functional abdominal pain is a complex interaction among impaired motility, visceral hypersensitivity and inadequate neuroendocrine and psychosocial responses. Peripheral and central nociception mechanisms seem to be involved in visceral hyperalgesia. Diagnosis requires detailed history and clinical evaluation, taking into consideration Rome II criteria. Based on known or assumed pathophysiological mechanisms, new drugs have been researched, and some have been more recently used to control abdominal pain, such as 5-HT4 receptor agonists and sodium channel blockers. CONCLUSIONS: Chronic pathophysiological abdominal pain mechanisms are still not well understood. Therapy and diagnosis require the understanding of such mechanisms, as well as of Rome II criteria. On the other hand, good patient-physician relationship and multidisciplinary team’s performance seem to be critical in improving treatment response and patients’ quality of life.

Keywords

PAIN, PAIN

References

Cervejo F, Laird J. Visceral pain. Lancet. 1999;353:2145-2148.

Cervejo F. Visceral hyperalgesia revisited. Lancet. 2000;356:1127.

Buéno L, Fioramont J, Garcia-Villar R. Pathobiology of visceral pain: molecular mechanisms and therapeutic implications-III. Visceral afferent pathways: a source of news therapeutic targets for abdominal pain. Am J Physiol Gastrointest Liver Physiol. 2000;278:G670-G676.

Gebhart GF. Pathobiology of visceral pain: molecular mechanisms and therapeutic implications-IV. Visceral afferent contributions to the pathobiology of visceral pain. Am J Physiol Gastrointest Liver Physiol. 2000;278:G834-G838.

Naliboff BD, Derbyshire SWD, Munakata JMS. Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation. Psychos Med. 2001;63:365-375.

Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000;47:861-869.

Drossman DA. Diagnosing and treating patients with refractory functional gastrointestinal disorders. Ann Intern Med. 1995;123:688-697.

Olden KW. Rational management of chronic abdominal pain. Comp Ther. 1998;24:180-186.

Janssen HAM, Borghouts JAJ, Muris JWM. Health status and management of chronic non-specific abdominal complaints in general practice. Br J Gen Prac. 2000;50:375-379.

Humphreys PA, Gevirtz RN. Treatment of recurrent abdominal pain: components analysis of four treatment protocols. J Pediatric Gastroenterol Nutrition. 2000;31:47-51.

Thompson WG, Longstreth GF, Drossman DA et al. Functional bowel disorders and functional abdominal pain. Gut. 1999;45:(Suppl II):II44-II47.

Jones J, Boorman J, Cann P. British Society of Gastroenterology guidelines for management of the irritable bowel syndrome. Gut. 2000;47(^sII):II1-II19.

Dapoigny M. Troubles fonctionnels intestinaux. La Revue du Practicien. 1999;49:1559-1564.

Talley NJ, Stanghelline V, Heading RC. Functional gastroduodenal disorders. Gut. 1999;45(^sII):II37-II45.

Corazziari E, Shafter EA, Hogan WJ et al. Functional disorders of the biliary tract and pancreas. Gut. 1999;45(^sII):II48-II54.

Bonica JJ. General Considerations of Abdominal Pain. The Management of Pain. 1990:1278-1281.

Guariso G, Mozizymas R, Benini F. Experience of recurrent abdominal pain: evaluation based on the eland scale. J Pain Symptom Manage. 1997;14:133-134.

Delaney BC, Innes MA, Deeks J. Initial management strategies for dyspepsia (Cochrane Review). Cochrane Database Syst Rev. 2001.

Jackson J, O’Malley P, Tomkins G. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med. 2000;169:65-72.

Poynard T, Naveau S, Mory B. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 1994;8:499-510.

Grillage MG, Nankani JN, Atkinson SN. A randomized, double-blind study of mebeverine versus dicyclomine in the treatment of functional abdominal pain in young adults. Br J Clin Pract. 1990;44:176-179.

Poynard T, Regimbeau C, Benhamou Y. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2001;15:355-361.

Scarpignato C, Pelosini I. Management of irritable bowel syndrome: novel approaches to the pharmacology of gut motility. Can J Gastroenterol. 1999;13(^sA):50A-65A.

Appel S, Kumle A, Hubert M. First pharmacokinetic-pharmacodynamic study in humans with a selective 5-hydroxyptamine4 receptor agonist. J Clin Pharmacol. 1997;37:229.

Thompson WG, Longstreth GF, Drossman DA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(^sII):43-47.

Junying G, Wenquan H, Yongping S. Dor Abdominal. Selecionando os Pontos Certos de Acupuntura. 1996:1228-1230.

Maike Regina de Lima. Fundamentos Essenciais da Acupuntura Chinesa. 1995:362-363.

Maciocia G. Dor Abdominal. A Prática da Medicina Chinesa. 1996:391-456.

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